Recent studies reveal that polycystic ovary syndrome (PCOS) might be associated with cardiovascular autonomic dysfunction, but with inconsistent results.The aim of this study is to investigate autonomic nervous systems in PCOS women such as heart rate variability, valsalva maneuver and Handgrip strength. These tests are non-invasive tests. Heart rate variability, a spontaneous variation in the rhythm of the human heart from one beat to the next, occurs in a healthy state, used to measure both sympathetic and parasympathetic activity. Handgrip strength, refers to the maximum static force a hand can exert by squeezing a dynamometer, used to measure sympathetic activity. And the Valsalva ratio (VR) used to measure parasympathetic activity. PubMed, Google Scholar and SCOPUS were searched for studies comparing cardiovascular function between women with obese and non-obese PCOS. PCOS diagnosis relies on Rotterdam's criteria, necessitating the presence of two out of three indicators: polycystic ovaries, anovulatory cycles, or hyperandrogenism as the syndrome transitions from a reproductive ailment to a metabolic disorder, characterized by features such as insulin resistance, impaired glucose tolerance, type 2 diabetes mellitus (DM2), dyslipidemia, and cardiovascular risk factors. 19 studies were included to analyze. Some of the studies resulted in heightened cardiac vagal modulation and reduced sympathetic cardiac modulation among a group of women with PCOS but most of them have demonstrated cardiovascular autonomic dysfunction, characterized by diminished vagal tone and heightened sympathetic activity, but observed in obese individuals compared to non-obese ones. Consequently, obesePCOS patients are believed to face an elevated risk of developing cardiovascular problems. These findings highlight the significance of early screening and management of metabolic abnormalities in women with PCOS, considering the connection between cardiac health and impaired autonomic function